Sixty patients with sub-capital or trans-cervical femoral neck fractures were randomized to receive internal fixation with either the Femoral Neck System (FNS) (n=30) or Multiple Cannulated Cancellous Screws (MCS) (n=30). The primary outcome of interest was femoral neck shortening at one year, measured on radiographs. Secondary outcomes included patient-reported outcomes using the modified Harris Hip Score (HHS) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) at final follow-up. Outcomes were assessed at one year. Overall, the results revealed that femoral neck shortening was significantly lower in the FNS group (3.77 ± 1.87 mm) compared to the MCS group (6.53 ± 1.59 mm). However, no statistically significant difference was found between the groups in terms of PROMs at one-year follow-up. These findings suggest that FNS may be a viable alternative to MCS for reducing femoral neck shortening in younger adults undergoing internal fixation for FNFs.